Clinical Nutrition ESPEN xxx (2018) e1ee7

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Clinical Nutrition ESPEN

journal homepage: http://www.clinicalnutritionespen.com

Randomized Controlled Trial

Omega-3 supplementation effects on body weight and depression

among dieter women with co-morbidity of depression and obesity
compared with the placebo: A randomized clinical trial
Seyed Ali Keshavarz a, Seyed-Ali Mostafavi b, *, Shahin Akhondzadeh b,
Mohammad Reza Mohammadi b, Saeed Hosseini a, Mohammad Reza Eshraghian c,
Maryam Chamari a
a
School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
b
Psychiatry & Psychology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences, Tehran, Iran
c
Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

a r t i c l e i n f o s u m m a r y

Article history: Purpose: We aimed to evaluate the effects of the omega-3 supplementation on body weight and
Received 9 July 2017 depression among women with co-morbidity of depression and obesity seeking weight reduction
Accepted 5 March 2018 compared with the placebo.
Methods: Sixty five patients with co-morbidity of depression and overweight/obesity (BMI
25)
Keywords: signed the informed consent form and enrolled into this 12-week double-blind, placebo-controlled
Body weight
randomized clinical Trial. Subsequently, participants randomly assigned into one of the two groups
Depression
receiving daily 6 capsules of omega-3 (each capsule containing 180 mg EPA, and 120 mg DHA) or 6
Obesity
Omega-3
capsules of placebo (two with each meal). We performed body composition assessments and Beck
Randomized clinical trial (RCT) depression inventory at the baseline, and weeks 2, 4, 8, and 12 after the start of the study. One month
Women after stopping the capsules at the follow-up visit, weight was measured to compare weight relapse
between the two groups.
Results: Forty five patients finished the study. No significant differences were seen between groups
regarding demographic and clinical variables at baseline. Using repeated measures ANOVA, omega-3
significantly reduced depression compared with the placebo (P ¼ 0.05). Mean ± SD weight reduction
in omega-3 group 3.07 ± 3.4 kg and in the placebo group was 1.16 ± 2.7 kg and the difference between
groups was significant using independent sample t-test (p ¼ 0.049). Patients in the omega-3 group did
not show significantly more side effects compared to the placebo but they were not successful in pre-
venting weight regain one month after the end of the study.
Conclusion: Based on our findings omega-3 capsule as a safe over-the-counter supplement might be
helpful in reducing the signs of depression and also body weight in patients with co-morbidity of
depression and obesity.
© 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights
reserved.

1. Introduction disease in 2030 [1]. The current prevalence of major depressive

Depression is a very common disorder. It will be the second
most important source of burden of disease after ischemic heart
* Corresponding author. Nutritional Neuro-psychiatry group, Psychiatry & Psy-
chology Research Center, Roozbeh Hospital, Tehran University of Medical Sciences,
Tehran, Iran.
E-mail address: mostafavi.n80@hotmail.com (S.-A. Mostafavi).
disorder (MDD) among Iran population is 4.1% (95% CI: 3.1e5.1).
Women are 1.95 (95% CI: 1.55e2.45) times more probable to have
MDD [2e4]. On the other hand, obesity is very common too, and it
is one of the most important risk factors for disabilities and mor-
tality. The prevalence of overweight and obesity in national studies
in adult was 21.7% (CI 95%: 18.5%e25%) [5].
Depression and obesity mostly coexist and are correlated with
each other [6,7]. The level of this correlation is different in different

https://doi.org/10.1016/j.clnesp.2018.03.001
2405-4577/© 2018 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

Please cite this article in press as: Keshavarz SA, et al., Omega-3 supplementation effects on body weight and depression among dieter women
with co-morbidity of depression and obesity compared with the placebo: A randomized clinical trial, Clinical Nutrition ESPEN (2018), https://
doi.org/10.1016/j.clnesp.2018.03.001
e2 S.A. Keshavarz et al. / Clinical Nutrition ESPEN xxx (2018) e1ee7
levels of body weight. The prevalence of depression was 11%, 12%,
and 23% among normal weight, overweight, and obese subjects,
respectively [8]. A meta-analysis have reported that obese in-
dividuals are 1.18 times more probable to have depressive symp-
toms with more likely observation in women [9]. Obesity in women
increases 37% risk of depression. When depression and obesity
happen together health consequences are more serious and treat-
ment of each depression or obesity by itself is complicated [8]. This
co-morbidity is the main reason for the failure of weight reduction
programs [8,10].
Many studies have ever been done on depression alone and
obesity alone. In fact, clinical studies to evaluate interventions
targeting both disorders are rare. Actually, in most of the in-
terventions to treat the obesity, patients with depression are usu-
ally excluded. Similarly, in most clinical interventions on
depression, gathering the information about eating behavior, and
weight gain are overlooked. On the other hand, despite being
known drug treatments for depression, but less than 50% (and even
in some countries less than 10 percent) of patients with depression
use these medications [11]. Barriers to the use of psychopharma-
cotherapy include lack of resources, lack of expertise and stigma as
well as the unwillingness of the medication consumption in some
people [11]. Therefore, finding a safe dietary supplement with more
access that can simultaneously target both obesity and depression
is very important.
There are pieces of evidence that show a dose-dependent effect
of omega-3 fatty acids in reducing symptoms of postpartum
depression and depression in the elderly. Emanuel and colleagues
in a 13-year-old cohort study of polyunsaturated fatty acids (PUFA)
and depression over 2744 people have observed that the relation-
ship between PUFA intake and depression was significant, indi-
cating a pattern of inappropriate and inadequate intake of dietary
sources of PUFA in people with depression [12]. Studies on the ef-
fects of omega-3 in reducing body weight are limited.
The aim of this study was to evaluate effects of the omega-3
supplementation on body weight and depression among women
with co-morbidity of depression and obesity seeking weight
reduction compared with the placebo.
The clinical trial registration number: IRCT2014053016465N3.
2. Methods
This was a 12-week parallel, double-blind, placebo-controlled
Randomized clinical Trial with no important changes to methods
after trial commencement. We acquired all necessary ethical per-
missions from ethics committee review board of Tehran University
of Medical Sciences, before patients' enrolment. We performed the
study in a weight reduction clinic. Sixty five patients with co-
morbidity of depression and overweight or obesity (Body Mass
Index; BMI
25) signed the informed consent form and then they
randomly assigned to one of the two groups receiving daily 6 cap-
sules of omega-3; each capsule containing 180 mg Eicosapentaenoic
acid (EPA), and 120 mg decosa-hexaene acids (DHA); Zahravi pharm.
Co. or 6 capsules of placebo (two with each meal). A third party was
used the computerized simple random allocation method to
generate the random allocation sequence. The groups were blinded
by placebo to participants and were blinded to the researcher by
coding (allocation concealment). Random allocation sequence and
subject enrollment were performed by a third party. A psychiatrist
enrolled to help in the diagnosis of depression by a semi-structured
clinical interview performed based on DSM-5 criteria.
Inclusion criteria were: 18e50 years old women, BMI
25,
Identification of depression by semi-Structured Clinical Interview
for DSM-5 criteria for depression based on SADS(Schedule for Af-
fective Disorders and Schizophrenia), signing the consent form.
Please cite this article in press as: Keshavarz SA, et al., Omega-3 supplementation effects on body weight and depression among dieter women
with co-morbidity of depression and obesity compared with the placebo: A randomized clinical trial, Clinical Nutrition ESPEN (2018), https://
doi.org/10.1016/j.clnesp.2018.03.001
Exclusion criteria: severe mental disorders, bipolar disorder and
schizophrenia, as well as severe depression, psychotic depression
or have suicidal thoughts, and those who were taking antidepres-
sants, consuming glucocorticoids, anti-inflammatory steroid, those
who take medication to reduce appetite or weight, those with
diabetes who take medication or insulin, those with heart disease
or hypercholesterolemia that take the medications, those who take
oral anti-inflammatory drugs, corticosteroids, or any medicine that
decrease or increase body weight, hormonal contraceptives, preg-
nancy and lactation, menopause, hypothyroidism, sport pro-
fessionals, those on special diets, allergy to fish or fish oil.
The sample size was determined to recognize the difference of
4 kg (m1em2 ¼ 4) between the omega-3 and placebo groups in the
Type I error a ¼ 0.05 and the power of 1-b ¼ 0.80. According to a
study by Hill AM and colleagues [13], the standard deviation for
weight was determined to be 4.8. Based on above information the
sample size of 21 was calculated to be sufficient.
The sample size was determined once again for secondary
outcome of depression so that we could able to detect a 5 point
difference of depression score between groups (m1em2 ¼ 5) in type
I error a ¼ 0.05 and with a power of 1-b ¼ 0.80. According to the
study of Su KP and colleagues [14], the standard deviation of
depression score was 3.7 and put into the formula for calculating
sample size Based on above information the sample size of 9 was
calculated to be sufficient.
Finally, we chose the larger sample size to cover all aims of the
study, to compensate for loss to follow up which is common in
clinical trials and also to raise the power of the study. So sampling
was continued to 32 patients in Omega-3 group and 33 patients in
the placebo group.
To eliminate the effect of diet, all the participants in the study
received a weight loss diet 500 to 1000 kcal of usual dietary
intake and we controlled that by using intermittent three-day food
records during the study. Furthermore, to coordinate and control for
the physical activity we recommended to all participants to keep
20 min of moderate physical activity that is available to everyone
and we inquired it in every visit. Sampling site was a weight loss
clinic. Anthropometric, and body composition assessments
(including body weight), Beck depression inventory, food craving
questionnaire, appetite and food abstinence visual Analogue scales
were performed at the baseline visit, and repeated two weeks, 4
weeks, 8 weeks and 12 weeks after the start of the study. One month
after stopping the capsules at the follow-up visit, weight was
measured to compare weight regain between the two groups.
A clinical dietitian preformed anthropometric assessments
including body weight, height, BMI, waist and hip circumferences.
Total body fat and muscle percentage, were estimated with body
composition analyzer all in standard situations. We used InBody270
BIA (InBody Co., Ltd) device which involves eight electrodes, a tetra-
polar electrodes in footpads and another 4 set of electrodes in the
handle. The subjects stood on the metal footpads in bare feet and
grasped a pair of electrodes fixed to a handle with arms extended in
front of the chest. This instrument assesses total body fat, visceral fat,
lean body mass, and basal metabolic rate as well as body weight and
BMI. The clinical validity of this instrument in measuring body
composition is already approved in comparison with Magnetic Reso-
nance Imaging (MRI) and Dual-Energy X-Ray Absorptiometry [15].
Furthermore, subjects were asked to fill a three-day food record.
Three-day food records were to be completed at home over two
non-sequential weekdays, and one day on a weekend, with the
days being assigned randomly. Subjects were instructed to record
everything that they eat or drink (including liquids, sweets, and
snacks). The portion sizes and scales were also delivered to them.
They were required to deliver the three-day food records in the
consequent visit.
 S.A. Keshavarz et al. / Clinical Nutrition ESPEN xxx (2018) e1ee7 e3

At the end, data gathered and analyzed by analysis of variance
(ANOVA) with repeated measures and independent sample t-test.
Then, the null hypothesis of similarity of weight (as the primary
outcome) and depression (as the secondary outcome) was tested
between groups and during the study period. Level of significance
adopted by the authors was set at 0.05 level.
3. Results
The periods of recruitment and follow-up were from February
2016 to April 2017. Twenty four patients in omega-3 group and 21
patients in placebo group finished the study and entered into the
analysis. Fig. 1 shows the Consort flow diagram of the study (Fig. 1).
Mean age and BMI of analyzed subjects was 42 years ± 9.9 and
33.4 ± 5.2, respectively. We did not observed any significant dif-
ferences between groups regarding age, total dietary calorie intake,
dietary EPA intake, dietary DHA intake, weight, depression score,
and demographic variables at baseline (Table 1).
Subjects on the omega-3 reduced more weight compared with
the placebo (Fig. 2). Mean ± SD weight reduction in omega-3 group
3.07 ± 3.4 kg and in the placebo group was 1.16 ± 2.7 kg and the
difference between group was significant using independent
sample t-test (t (43) ¼ 2; p ¼ 0.049; 95%CI:0.008e3.8). Then, we
performed repeated measures ANOVA and the interaction effect of
group and time was also significant F ¼ (1, 43) ¼ 2.9, P ¼ 0.07.
We performed repeated measures ANOVA to compare the main
effects of omega-3 and placebo and the interaction effect between
groups during the study on depression score in subjects with co-
morbidity of obesity and depression. Omega-3 significantly
reduced depression compared with the placebo, F ¼ (1, 37) ¼ 4.07,
P ¼ 0.05. The interaction effect of group and time was also signif-
icant F ¼ (1, 37) ¼ 5.6, P ¼ 0.008; Fig. 3.
We performed repeated measures ANOVA to compare the main
effects of omega-3 and placebo and the interaction effect between
groups during the study on Visual Analogue Scale for appetite in
subjects with co-morbidity of obesity and depression. There was

Fig. 1. Flow Diagram of the study (CONSORT 2010).

Please cite this article in press as: Keshavarz SA, et al., Omega-3 supplementation effects on body weight and depression among dieter women
with co-morbidity of depression and obesity compared with the placebo: A randomized clinical trial, Clinical Nutrition ESPEN (2018), https://
doi.org/10.1016/j.clnesp.2018.03.001
e4 S.A. Keshavarz et al. / Clinical Nutrition ESPEN xxx (2018) e1ee7

Table 1 not a significant effect of omega-3 on appetite, F ¼ (1, 43) ¼ 1.0,

Baseline demographic and clinical characteristics for each group. P ¼ 0.32. The interaction effect of group and time was not also
Omega-3 Placebo significant F ¼ (1, 43) ¼ 1.3, P ¼ 0.26; Fig. 4.
Mean ± SD/N (%) Mean ± SD/N (%) We performed repeated measures ANOVA to compare the main
Age 41 ± 9.9 44 ± 9.5 effects of omega-3 and placebo and the interaction effect between
Total daily dietary calorie intake (Kcal) 1808 ± 239 1750 ± 187 groups during the study on Visual Analogue Scale for food absti-
Dietary intake of EPA (mg) 0.017 ± 0.04 0.013 ± 0.04 nence in subjects with co-morbidity of obesity and depression.
Dietary intake of DHA (mg) 0.05 ± 0.12 0.03 ± 0.12
There was not a significant effect of omega-3 on food self-restraint,
Weight (kg) 81.7 ± 12.6 82.5 ± 15.0
Waist circumference (cm) 103.3 ± 11.2 106.1 ± 11.9 F ¼ (1, 43) ¼ 1.19, P ¼ 0.28. The interaction effect of group and time
Hip circumference (cm) 115.1 ± 10.3 114.7 ± 10.7 was not also significant F ¼ (1, 43) ¼ 0.8, P ¼ 0.4; Fig. 5.
Body fat percentage 44.4 ± 5.6 45.1 ± 5.7 There was not any significant difference between the omega-3
Beck depression score 19.8 ± 8.4 20.9 ± 5.9
and placebo during the study regarding Food Craving Question-
Age at onset of obesity
Before puberty (type I obesity) 2 (8.3%) 0 (0%)
naire score in subjects with co-morbidity of obesity and depres-
After puberty (type II obesity) 22 (91.7%) 21 (100%) sion; F ¼ (1, 42) ¼ 0.20, P ¼ 0.65.
Education level One month after the end of the study, we observed 2.8 ± 3.6 kg
high school diploma or lower 16 (66.6) 14 (66.7) weight return in the omega-3 group, but subjects in the placebo group
under graduate education 4 (16.7) 5 (23.8)
had reduced 0.21 ± 0.9 kg. The difference between groups was sig-
post graduate education 4 (16.7) 2 (9.5)
Economic status nificant (independent sample t-test; t (22.3) ¼ 3.5; p ¼ 0.002).
low 3 (12.5) 6 (28.6) Five cases reported side effects in the omega-3 group (one cases
middle 21 (87.5) 15 (71.4) reported skin rash, two case reported nausea, one case reported
high 0 (0) 0 (0) hemoragia and one case reported increased appetite), and 4 cases
Marital status
single 4 (16.7) 1 (4.8)
reported side effects in the placebo group (two cases reported skin
married 19 (79.1) 19 (90.4) rash, one case reported nausea, and one case reported increased
widowed 1 (4.2) 1 (4.8) appetite). Different between groups regarding side effects were not
Child delivery number significant (fisher's exact test; p ¼ 0.7).
0 6 (25) 1 (4.8)
1 6 (25) 6 (28.6)
2 8 (33.3) 5 (23.8) 4. Discussion

3 4 (16.7) 9 (36.8)

EPA: Eicosapentaenoic acid DHA: docosahexaenoic acid. The main finding of this study was that Omega-3 at the dose of
1080 mg EPA þ 720 mg DHA/day significantly reduced depression

Fig. 2. Comparing the main effects of omega-3 and placebo during the study period on body weight.

Please cite this article in press as: Keshavarz SA, et al., Omega-3 supplementation effects on body weight and depression among dieter women
with co-morbidity of depression and obesity compared with the placebo: A randomized clinical trial, Clinical Nutrition ESPEN (2018), https://
doi.org/10.1016/j.clnesp.2018.03.001
 S.A. Keshavarz et al. / Clinical Nutrition ESPEN xxx (2018) e1ee7 e5

Fig. 3. Comparing the main effects of omega-3 and placebo during the study period on Beck Depression Inventory Score using repeated measures ANOVA.

Fig. 4. Comparing the main effects of omega-3 and placebo during the study period on Visual Analogue Scale for appetite using repeated measures ANOVA.

Please cite this article in press as: Keshavarz SA, et al., Omega-3 supplementation effects on body weight and depression among dieter women
with co-morbidity of depression and obesity compared with the placebo: A randomized clinical trial, Clinical Nutrition ESPEN (2018), https://
doi.org/10.1016/j.clnesp.2018.03.001
e6 S.A. Keshavarz et al. / Clinical Nutrition ESPEN xxx (2018) e1ee7

Fig. 5. Comparing the main effects of omega-3 and placebo during the study period on Visual Analogue Scale for food abstinence using repeated measures ANOVA.

compared with the placebo. At various times, some studies have
reported the effects of omega-3 on reducing depression and mood
disorders, Tajalizadekhoob Y. and colleagues [16] in a double blind
study on 66 old patients with mild to moderate depression, used
daily 300 mg of Eicosapentaenoic acid (EPA) and Docosapentaenoic
acid (DHA) (active ingredient of fish oil) for 6 months. They found a
significant change (p  0.001) in the Geriatric Depression Scale-15
(GDS-15) of those receiving omega 3 (n ¼ 29) compared with the
placebo (n ¼ 26) using tow-way ANOVA. Rondanelli and colleagues
[17] also used omega-3 fatty acids in elderly women with depres-
sion in a 2-month clinical study. The group receiving omega-3
(n ¼ 24), received 1.6 g of EPA and 0.83 g of DHA and the control
group (n ¼ 22) received identical placebo. GDS test scores were
compared before and after 8 weeks and a significant reduction was
observed in the group receiving omega-3.
Sinn N and colleagues [18] in a study to assess the effects of
different doses of omega-3 fatty acids on depressive symptoms of
elderly patients suffering mild to moderate depression, applied 50
elderly patients for period of 6 months. A group consisting of 17
patients mainly received EPA (EPA ¼ 1.67 g/day þ DHA ¼ 0.16 g/
day). The other group consisted of 18 patients received mainly DHA
(DHA ¼ 1.55 g/day þ EPA ¼ 0.4 g/day) and the third group (n ¼ 15)
received n-6 PUFA (LA ¼ 2.2 g/day). They compared GDS score
between groups. GDS score in the group receiving dominant EPA
(P ¼ 0.04) and DHA (P ¼ 0.01) was significantly improved.
Arbabi and colleagues [19] in a study on postpartum model of
depression in rats reported antidepressant effects of omega-3.
Furthermore, Nahidi and colleagues [20] in the 4-week study of
70 women with postpartum depression assessed omega-3 effects
on depression. They randomly divided participants into two groups
of 35 patients receiving a daily one gram of omega-3 or placebo.
The Beck questionnaire was used to assess depression symptoms
during the study. The severity of depression in the group receiving
omega-3 significantly decreased (P ¼ 0.001).
In another study, Jazayeri Sh. and colleagues [21] compared the
therapeutic effects of omega-3 fatty acids (1000 mg EPA), Fluoxe-
tine (20 mg) and a combination of omega-3 and Fluoxetine. These
researchers observed that the combination of omega-3 and
Fluoxetine significantly better decreased depression symptoms
compared with Fluoxetine or omega-3 alone. Interestingly, the
therapeutic effect of omega-3 alone in controlling the symptoms of
depression was similar to that of Fluoxetine. Meta-analysis studies
[22] show a more effect of EPA than DHA in reducing symptoms of
depression. Sablt and colleagues [22] divided the clinical studies of
omega-3 on depression into two categories: studies that the EPA
dose was <60% of the total EPA þ DHA and other studies that EPA
was
60% of the total. And showed that supplementation with
EPA
60% has a better effect on the improvement of depressive
symptoms. The EPA dose was at 200e2200 mg per day range. The
results of our study were in line with aforementioned studies. All
above studies indicate that therapeutic doses of omega-3 are
effective in reducing symptoms of mild to moderate depression.
Studies on the effects of omega-3 on body weight are rare.
DeFina LF. and colleagues [23] performed a study to examine the
effects of omega-3 on body weight loss in non-depressed obese or
overweight subjects. They randomly assigned 128 eligible in-
dividuals with BMI between 26 and 40 into two groups receiving
daily 5 capsules of omega-3 (3 g of EPA and DHA at a ratio of 5 to 1)
(n ¼ 64) and five placebo capsules (n ¼ 64). Both groups received
dietary and exercise counseling. Eighty-one patients finished the
24-weeks of the study. Both omega-3 (5.2 kg; 95%
CI: 6.0e4.4 kg) and placebo (5.8 kg; 95% CI: 6.7e5.1 kg)

Please cite this article in press as: Keshavarz SA, et al., Omega-3 supplementation effects on body weight and depression among dieter women
with co-morbidity of depression and obesity compared with the placebo: A randomized clinical trial, Clinical Nutrition ESPEN (2018), https://
doi.org/10.1016/j.clnesp.2018.03.001
 S.A. Keshavarz et al. / Clinical Nutrition ESPEN xxx (2018) e1ee7
reduced more than 5% of their body weight. No significant differ-
ence was observed in body weight between both groups. The dif-
ference in mean body weight changes ± SEM
0.61 ± 0.58 kg (P ¼ 0.29). But, we observed a small effect of omega-
3 in reducing body weight in patients with co-morbidity of
depression and obesity consuming omega-3 capsules (at the dose
of 1080 mg EPA þ 720 mg DHA per day).
In the present study, we hypothesized that if omega-3 can help
to reduce body weight, this effect may be more obvious in subjects
with co-morbidity of obesity and depression. So we designed our
study and proposed that omega-3 may help better controlling
appetite and body weight through improving mood disorders and
reducing depression. In designing the study, we choose to include
weight reduction seeking women with co-morbidity of obesity and
depression. We tried to eliminate the effects of different diets by
prescribing similar 500 kcal to 1000 kcal of regular dietary
intake in both groups and control for most known confounding
factors to be able to detect the pure effect of omega-3 on body
weight. The main finding of the current study was that omega-3
may help to reduce body weight through significantly reducing
depression symptoms more than placebo.
One concern about omega-3 supplementation in depressed di-
eters was weight regain after finishing supplementation we
observed in the follow-up period. However, omega-3 did not
impose any serious side effects in comparison with placebo.
5. Limitations
The main limitation was the target sample of this study which
limits the results to dieter women with overweight or obesity and
mild to moderate depression.
6. Conclusion
Based on our findings omega-3 capsule (at the dose of 1080 mg
EPA þ 720 mg DHA/day) may be helpful in reducing body weight,
and as a safe over the counter supplement, it is helpful in patients
with co-morbidity of depression and obesity in reducing the
symptoms of depression. At the follow-up visit, we found that
patients with omega-3 regained 2.8 kg of their loosed weight. After
weight reduction adjunct with omega-3 capsules more support
should be anticipated to prevent weight regain. We encourage that
future investigations put this point at their spotlight. No serious
side effect was observed in administration of omega-3 at 1800 mg/
day dose.
Conflict of interest
All authors declare no conflict of interest related to this work.
Acknowledgement
This study was part of a PhD thesis supported by Tehran Uni-
versity of Medical Sciences (TUMS); Grant no 22516.
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with co-morbidity of depression and obesity compared with the placebo: A randomized clinical trial, Clinical Nutrition ESPEN (2018), https://
doi.org/10.1016/j.clnesp.2018.03.001
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